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An outbreak of viral meningitis associated with a public swimming pond

Published online by Cambridge University Press:  22 December 2004

A. M. HAURI
Affiliation:
Government Health Service Institute, Dillenburg, Germany
M. SCHIMMELPFENNIG
Affiliation:
Public Health Office, Kassel, Germany
M. WALTER-DOMES
Affiliation:
Public Health Office, Kassel, Germany
A. LETZ
Affiliation:
Public Health Office, Kassel, Germany
S. DIEDRICH
Affiliation:
National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
J. LOPEZ-PILA
Affiliation:
German Environmental Office, Berlin, Germany
E. SCHREIER
Affiliation:
National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
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Abstract

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From July to October 2001, 215 cases of aseptic meningitis occurred among the inhabitants of the German city of Kassel and neighbouring counties. A matched case-control study identified bathing in a public, nature-like pond during the beginning of the outbreak as a risk factor for disease [matched odds ratio (mOR) 44·8, 95% confidence interval (CI) 3·9–515·6]. Among bathers, patients with meningitis spent more time in the water (mOR 18·8, 95% CI 2·0–174·1) and swallowed water more frequently (mOR=7·3, 95% CI 0·7–81·8). Of 30 cerebrospinal fluid samples tested, echovirus 30 was cultured from 16, and echovirus 13 from seven. An echovirus 30 sequence obtained from one pond water sample showed a 99% nucleotide and 100% amino-acid homology with patient isolates. This outbreak demonstrates the potential of nature-like swimming ponds to cause widespread community infection with substantial public health impact.

Type
Research Article
Copyright
© 2004 Cambridge University Press